A tough after-beginning with the Affordable Care Act

New York Methodist Hospital-WeillCornell, an 850+ bed tertiary care hospital in Park Slope, Brooklyn. one of 5 prominent hospitals in NY state has an annual Memorial Lecture in recognition of the former Chief of Orthopedic Surgery. The brother of the deceased is the democratic State Senate leader, Sheldon Silver, from the lower east side of Manhattan. He tells the joke about his brother, the doctor, keeping him focused on the health needs of the community. There is the old Yiddish joke about the mother who recieves a call ferom Washington informing her that her son is elected President (of course this Prez must go to bed every night asking, who needs this! The mother responds, “That’s wonderful, but you know his brother is a DOCTOR!” We have something like that with the Chicago Emanuel brothers.

If you asked her today, she would say, OY! My son the doctor. We are somehow adapting at the same time we are reacting.

This article just appeared in Medscape online.

Official photographic portrait of US President Barack Obama (born 4 August 1961; assumed office 20 January 2009) (Photo credit: Wikipedia)

English: This is an image of Donald Berwick, who is the Administrator for the US Federal Center for Medicare and Medicaid Services (CMS). CMS is part of the US Department of Health and Human Services. The source website is federally managed by the Department of Health and Human Services. (Photo credit: Wikipedia)

Sticking to their party’s game plan to dismantle the Affordable Care Act (ACA) piece by piece, Sen. John Cornyn (R-TX) and Sen. Orrin Hatch (R-UT) Thursday reintroduced a bill to repeal a controversial Medicare cost control mechanism in the law that is widely opposed by organized medicine.

The cost control mechanism is the Independent Advisory Payment Board (IPAB). The 15-member board must include physicians, but healthcare providers of any stripe must not constitute the majority of the board. Its mission is to advise Congress on how to curb the per capita growth of Medicare spending if it exceeds growth rate targets set by the law. If Congress does not implement IPAB recommendations, it must either enact legislation that saves just as much or let the Department of Health and Human Services make the cuts.

The IPAB, which a reintroduced GOP bill in the House also seeks to repeal, has come under fire from political conservatives and medical societies for offering too much power to a collection of “bureaucrats” who are largely unaccountable to Congress. Critics also warn that it will end up rationing care and subjecting physicians to unfair pay cuts just as Medicare’s sustainable growth rate formula has done.

The ACA explicitly prohibits the IPAB from rationing care or recommending any measures that would reduce Medicare eligibility and benefits or increase costs borne by beneficiaries. Supporters say that the IPAB would perform a salutary end-run around a Congress that is under the sway of healthcare industry lobbyists who protect provider reimbursement to the detriment of the public good.

The Senate bill to repeal the IPAB has 31 sponsors, all Republican. Even if the bill passed in the Senate with Democratic support and sailed through the Republican-controlled House, President Barack Obama is poised to veto it, according to a previous White House pronouncement.

The president has yet to nominate anyone to serve on the IPAB. His appointments under the law require the advice and consent of the Senate. Given that Republicans command enough votes to filibuster any nomination, the IPAB could remain 15 empty chairs, although the president could temporarily fill them through appointments made while the Senate is in recess.

In another new attack on the ACA, Rep. Charles Boustany Jr (R-LA) and Rep. Jim Matheson (D-UT) reintroduced a bill today to repeal an excise tax on health insurers in the law that will raise roughly $100 billion in revenue over 10 years. In addition, earlier this month, a bipartisan group of senators introduced legislation to eliminate an ACA tax on medical devices, which some physicians say will boost the price of diagnostic imaging and other medical equipment during a time of declining reimbursement. The Congressional Budget Office estimates that the device tax will bring $30 billion into the federal treasury.

Any repeal of tax provisions in the ACA presents a Congress committed to deficit reduction with the thorny problem of offsetting revenue losses with either spending cuts or revenue increases elsewhere in the federal budget.